Most people have heard the phrase ‘fight-or-flight’, which describes a response to perceived threat: faced with an aggressive competitor for food or mates, animals have the choice either to respond in kind (fight) or to run (flight). The choice is simple, but it will be influenced by a variety of factors. If the animal is protecting eggs or young from a predator, for example, it might be more likely to fight than to flee; confronted with an overwhelming threat like a wildfire, animals will always choose flight. The emotional components of fight or flight might be different – aggression or fear – but the physiological response involves the same cascade of hormones. The most prominent of these is adrenaline, which facilitates action by increasing heart-rate and blood pressure. There is always adrenaline in your system, but the inner part of the adrenal gland is specialised to secrete large amounts of it very rapidly in response to demand.
The physiological process of fight-or-flight is the same in all animals, including humans, and the intensity of the demand determines the amount of adrenaline produced. To use a human example, if you’re quietly reading a book and someone calls your name, you look around to see who it is. This orienting response involves an increase in adrenaline, but the physiological effect is almost imperceptible. If the person who calls your name is someone you’re madly in love with you’d probably be aware of the change, and if instead of your name being called you heard a sudden loud bang, you’d soon notice your pounding heart!
These varying responses are ranged along a continuum, but mild or extreme, the effect is an increase in adrenaline to facilitate whatever action might be required. Simultaneously, there is an increase in another adrenal hormone called cortisol, which aids fight-or-flight by controlling the inflammation that would occur if we were injured in an emergency. It also facilitates the release of stored sugar, to provide the extra energy we need, and it conserves energy by temporarily suspending the production of certain white blood cells.
If you then realised that the loud bang you heard was just the ladder you left outside toppling over in the wind, your heart rate returns to normal quite quickly – your body is governed by the homeostatic principle, and returns to a resting state as soon as possible. This will minimise the strain caused by prolonged elevations in heart rate and blood pressure; what happens biochemically is that the excess adrenaline is rapidly metabolised because it is no longer needed. The same occurs for the excess cortisol, so that white blood cell counts can return to normal and restore effective immune functioning.
Intermittent increases in arousal followed by recovery are a natural response to changing demands in our everyday life, but they have been confused with stress by calling them ‘acute stress’. They are simply changes in pressure. On the other hand, if the demand was continuous – chronic stress – the strain on your body would eventually lead to exhaustion and deteriorating health. Continuous external demand is very rare: in our everyday lives, after a period of demand there is always an opportunity for recovery. However, while external pressure comes and goes, what might become chronic is internal pressure: continuing to ruminate about emotional upsets. If you close your eyes and think about an upsetting incident your blood pressure and heart-rate rise, yet all you’re fighting or fleeing from is a thought in your head. Rumination transforms fluctuating pressure into stress, and the misery of churning over emotional upsets significantly impacts your health and well-being. Rumination is what stress really is, and you have a choice whether or not to ruminate: one of the most important consequences of defining stress in this way is that it liberates you from becoming a mere victim of circumstance.
There are two more F-words: flail and freeze. When people are caught up in life-threatening emergencies they might be so overcome by fear that they either go into a flailing, blind panic or are completely stopped in their tracks and don’t act at all. Other animals will sometimes freeze as part of fight-or-flight: if they remain perfectly still a predator is less likely to see them, and this is an adaptive response when fighting or fleeing might not work. Human freezing or panicking are a consequence of being overwhelmed by emotion, and are not adaptive, but what has happened is that the element of choice has been compromised: people who respond in this way have been pushed beyond the threshold of rational decision-making that we described in an earlier blog (Blog 41, ‘Carried Over The Threshold’).
Extreme situations don’t normally last all that long, but if the intense rumination about them continues there is a real risk of the response becoming firmly established. This is what post-traumatic stress disorder (PTSD) is about. The term PTSD is over-used – the proportion of people who can reliably be diagnosed as having the disorder is actually very small, even after exposure to major traumas. However, that shouldn’t detract from the real suffering experienced by people who genuinely have it: symptoms include disturbed sleep, emotional lability, and recurring flash-backs to the event which provoke all of the emotions over again. The root cause is rumination, but choice has been compromised and the emotional triggering of the symptoms has become crystallised.
Genuine PTSD is thankfully rare, and it is addressed by intensive, one-on-one counselling. By contrast, the Challenge of Change Resilience training programme is designed to address what we call everyday stress, and is delivered in group training sessions. What’s required to be free of everyday stress is to take all four steps in the training programme, culminating in letting go, and you can’t let go until you’ve woken up, regained control of your attention and taken a detached perspective. What you let go of is the paralysing emotion that compromises action. Even if all you’re ruminating about is the negative comment from your boss about the last piece of work you did, it isn’t easy to do, but we know from our follow-up research that habitually ruminating about everyday issues like this can be completely changed with diligent practice.